Medical Assistant Position Statement

Question: What is the Role of the Licensee with regard to supervision and delegation to the Medical Assistant?

Clinical Advisory
New Hampshire Board of Nursing
Relative to the Role of the Licensee with regard to supervision and delegation to the Medical Assistant

Introduction: The Board of Nursing recognizes that licensed nurses partner with health care providers in many diverse roles in order to meet the needs of the patients across the continuum of settings.

In contrast to nurses, Medical Assistants (MAs) do not hold a license to practice and are therefore not regulated by the state of NH or any other entity.

As an integral role in the office practice setting the Medical Assistant (MA) presents a unique challenge to the licensed nurse. While many MAs have received structured formal education, the role is unregulated and therefore open to individuals with widely varying backgrounds and education.

The following parameters established by the Board of Nursing are intended to guide the licensed nurse in his/her supervision of and delegation to the MA.

Accountability and Responsibility: Prior to any act of delegation to an MA, the licensed nurse following the Administrative Rules of NUR 404, must determine the competency of the MA to perform the delegated task.
With the exceptions listed below, the licensed nurse may delegate any basic clinical activities in which the MA has demonstrated competency and skills.

Formal structured education, with recognized certification, is a preferred element in the determination of competency of the MA. In the absence of documented competencies for tasks and screenings, sample competencies are attached. (Appendix 1)
Licensees are advised to ensure documentation of appropriate competencies is accessible in the practice setting. The licensee needs to ensure that expectations and assumptions regarding his/her supervisory/delegatory role are clearly communicated to all members of the health care team.

Delegation of tasks and screenings appropriate for delegation to the MA may vary widely depending on the practice setting. Therefore this document addresses those tasks and screenings by exception as follows

Medication Administration; Medication administration, with the exception of narcotics, may be delegated provided that

The competency requirement of NUR 404 has been met and documented

Evidence of formal structured pharmacology education is preferred but not required

Any non unit dose medication requiring calculation must be double checked with the licensee prior to administration

IV medication administration may not be delegated
Controlled substance administration may not be delegated

Suture Removal: Suture removal may only be delegated when:

Suture removal is from a simple incision or superficial laceration

IV therapy

Licensees may not delegate any element of IV insertion or IV therapy including
but not limited to central venous access

Triage is commonly defined as the sorting of patients and prioritizing of care based on the degree of urgency and complexity of patient conditions. Telephone triage is the practice of performing a verbal interview and making a telephonic assessment with regard to the health status of the caller. As the caller may not accurately describe symptoms, and/or may not accurately perceive or communicate the urgency of the situation or condition prompting the call, nurses who perform these functions must have specific educational preparation, as the consequences of inadequate triage can be devastating.

Nur 404.06 (b) 2&3 states that:

In exercising such discretion in delegation as is permitted by Nur 404, a licensee intending to delegate a task of client care shall take into account:
(2). Whether the client is stable; and
(3) Whether the client’s nursing needs are currently changing

Therefore, telephone triage, which involves assessment and disposition, may not be delegated by a licensee to an MA. The function that may be delegated is phone screening, which involves systematic collection of demographic data and documentation of a symptom list.